Provider Demographics
NPI:1962975789
Name:NATIONAL COUNCILON ALCOHOLISM AND DRUG DEPENDENCE
Entity type:Organization
Organization Name:NATIONAL COUNCILON ALCOHOLISM AND DRUG DEPENDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:EZEQUIEL
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-997-0414
Mailing Address - Street 1:6166 VESPER AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2851
Mailing Address - Country:US
Mailing Address - Phone:818-997-0414
Mailing Address - Fax:818-997-0851
Practice Address - Street 1:6166 VESPER AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-2851
Practice Address - Country:US
Practice Address - Phone:818-997-0414
Practice Address - Fax:818-997-0851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty